10/31/2023
We don't often share long articles, but this one is a must-read because it directly impacts you as a customer. Whether you have health, home, auto insurance, or all of them, it's crucial to stay informed and educated about the ever-evolving industry that does not work in your favor by design.
βOne possible way insurers limit how much they pay on claims is by simply paying less on a batch of claims and seeing how many customers complain. If the number of complaints doesn't reach a certain threshold β say, 5% of claim decisions result in a formal complaint β then the amount paid is lowered even further with another batch of claims. The process of lowering payouts, which can be automated by AI tools, is continued until that threshold of complaints is reached.
Insurers can also use their data-driven analysis of customers to predict who is prone to complain and preemptively offer them a fairer deal than those who are more likely to just accept what they are offered. Or, they can target customers with low credit scores β which indicates they might have money troubles and need cash right now β and offer them a quicker, no-hassle process in return for a reduced payout.
In addition to dragging out claims until customers just give up, recent reporting by ProPublica found that the health insurer Cigna uses a system that helps doctors instantly reject a claim on medical grounds without opening the patient file, forcing customers to go through a tortuous appeals process. "Cigna adopted its review system more than a decade ago," writes ProPublica, "but insurance executives say similar systems have existed in various forms throughout the industry."
Link to the full article in comments. It is more important than ever to speak up to your insurance company. They are a business and you are their client.
Home, health, and auto insurers are using creepy new technology to jack up your premiums and deny your claims.